Healthcare Provider Details

I. General information

NPI: 1083307490
Provider Name (Legal Business Name): ALEXIS ZUCKER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2023
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18715 N REEMS RD STE 100
SURPRISE AZ
85374-8643
US

IV. Provider business mailing address

6611 E MAYO BLVD UNIT 1075
PHOENIX AZ
85054-4509
US

V. Phone/Fax

Practice location:
  • Phone: 623-975-3115
  • Fax:
Mailing address:
  • Phone: 480-888-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD011787
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: